Information Collection

Public Health and Medical Emergency Planners/Key Informants - Questionnaire

IC 228842 under ICR 201803-0920-018 · OMB 0920-1221.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1221 can be found here:

Documents and Forms

Document Name Document Type
Public Health and Medical Emergency Planners/Key Informants - Questionnaire Form and Instruction
Key Informant/Stakeholder Questionnaire AttC-Questionnaire.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Public Health and Medical Emergency Planners/Key Informants - Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	NA	Key Informant/Stakeholder Questionnaire	AttC-Questionnaire.docx	NA	No		Paper Only

Line of Business: Disaster Management

Subfunction: Disaster Preparedness and Planning

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.